| NPI | 1871572966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P9281) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 38162) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2024-03-21 |